Coherent Connections: Wiring the Patient Centered Medical Home in a Meaningful Way August 18, 2009

Coherent Connections:Wiring the Patient Centered Medical Home

in a Meaningful WayAugust 18, 2009

David C. Kibbe, MD, MBA, Senior Advisor, American Academy of Family Physicians, and Chair,

ASTM International E31Technical Committee andPrincipal, The Kibbe Group

Dennis Saver, MD <need info>

The Health IT Landscape

– “Meaningful Use” Defined

– EHR Certification Who will certify,

and when?

Meaningful Use: Meaningful Connections• Identifies health IT as a “critical

platform” of the PCMH.• (Re) Conceptualizes health IT as

an e-platform and set of tools.• Health IT functional priorities to

support a PCMH. • Critical capabilities to engage

consumers with health IT. • Explores the current use of health

IT by primary care physicians.

Cross Walk: HIT for PCMH withMeaningful Use Objectives

Ability to collect, store, manage and transmit health data

Ability to communicate and exchange care planning

Ability to report quality and performance measures

Ability to engage decision support and evidence-based systems

Ability to inform and educate patients online

Improve quality, safety, and efficiency, and reduce health disparities

Engage patients and families

Improve care coordination

Improve population and public health

Ensure privacy and security protections for personal health information

CeHIA Meaningful Connections Report: Capabilities

HIT Policy CommitteeRecommendations: Priorities

"Health Outcomes Policy Priorities" from the HIT Policy Committee

Defining Meaningful Use

. “Ability of providers and practices to engage in decision support for evidence-based treatments and tests.”

2011 Objective:

“Improve quality, safety, efficiency, and reduce health disparities.”

Eligible Providers:- Implement drug-drug, drug-allergy, drug-formulary checks.- Maintain up-to-date problem list of current and active diagnoses based on ICD-9 or SNOMED.- Generate and transmit permissible prescriptions electronically (eRx).- Maintain active medication list and active medication allergy list.- Record demographics: preferred language, insurance type, gender, race, ethnicity.- Record advance directives.- Record vital signs: height, weight, blood pressure, calculate and display BMI.- Record smoking status.- Incorporate lab-test results into EHR as structured data.- Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, and outreach.- Report ambulatory quality measures to CMS- Send patient reminders, per patient preference for prev/follow-up care.- Implement one clinical decision rule relevant to specialty or high clinical priority.- Document a progress note for each encounter.- Check insurance eligibility electronically from public and private payers, where possible.- Submit claims electronically to public and private payers.

Defining Meaningful Use

. “Ability of providers and practices to engage in decision support for evidence-based treatments and tests.”

2011 Objective:

“Improve quality, safety, efficiency, and reduce health disparities.”

2011 Measures:- Report quality measures to CMS including:- % diabetics with A1c under control.; % hypertensive patients with BP under control; % of patients with LDL under control; % of smokers offered smoking cessation counseling; % of patients with recorded BMI; % eligible surgical patients who receive VTE prophylaxis; % of orders (for meds, lab tests, procedures, radiology, and referrals) entered directly by physicians through CPOE.- Use of high-risk medications (Re: Beers criteria) in the elderly.- % of patients over 50 with annual colorectal cancer screenings.- % of females over 50 receiving annual mammogram.- % of patients who received flu vaccine.- % lab results incorporated into EHR in coded format.- Stratify reports by gender, insurance. type, primary language, race, ethnicity.-% of all meds entered into EHR as generic, when generic options exist in the relevant drug class.-% of orders for high-cost imaging services with specific structured indications recorded.- % claims submitted electronically to all payers.- % patient encounters

Defining Meaningful Use

. “Ability of consumers and patients to be informed and literate about their health and medical conditions and appropriately self-manage with monitoring and coaching from providers.”

2011 Objective:

“Engage patients and families.”

Eligible Providers:-Provide patients with an electronic copy of their health information (including lab results, problem list, medication lists, allergies) upon request.-Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies).- Provide access to specific educational resources.- Provide clinical summaries for patients with each encounter.

2011 Measures:-% of all patients with access to personal health information electronically.-% of all patients with access to patient-specific educational resources.-% of encounters for which clinical summaries were provided..

Defining Meaningful Use

. “Ability of providers, patients and other members of the care team to communicate.”

2011 Objective:

“Improve care coordination.”

Eligible Providers:- Capability to exchange key clinical information (e.g., problem list, medication list, allergies, test results) among providers of care and patients’ authorized entities electronically. [per HIE workgroup] - Perform medication reconciliation at relevant encounters and each transition of care.

2011 Measures:- Report 30-day readmission rate.- % of encounters where med reconciliation was performed.- Implemented ability to exchange health information with external clinical entity (specifically labs, care summary, and medication lists).- % of transitions in care for which summary care record is shared (e.g. electronic, paper, e-Fax).

Defining Meaningful Use

. “Ability to collect, store, measure and report on the processes and outcomes of individual and population performance and quality of care.”

2011 Objective:

“Improve population and public health.”

Eligible Providers:-Capability to submit electronic data to immunization registries and actual submission where required and accepted.-Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.

2011 Measures:-Report up-to-date status for childhood immunizations.-% reportable lab results submitted electronically.

Defining Meaningful Use

. “Ability to collect, store, manage and exchange relevant personal health information”

2011 Objective:

“Ensure privacy and security protections for personal health information.”

Eligible Providers:- Compliance with HIPAA Privacy and Security Rules.-Compliance with fair data sharing practices set forth in the Nationwide Privacy and Security Framework

2011 Measures:-Full compliance with HIPAA Privacy and Security Rules.-Conduct or update a security risk assessment and implement security updates as necessary.

Cross-Walk: MU Requirements andCertifiable EHR Technology Components

Access eligibility and submit claims online.

Generate and refill ePrescriptions.

-Meds Decision Support, e.g. drug-drug, etc.

Maintain active patient data, structured format.

-Demographics, Problems, Medications

-Allergies, Vital Signs, Immunizations

-Advance directives, Lab results, Smoking hx

Generate progress note at each visit.

Generate lists of patients by condition.

Generate reports per CMS measures.

Implement at least one CDS rule.

Enable pts. to view/receive copy of summary data.

Enable pts. to access education, coaching.

Enable exchange of summary health data.

Generate reports for public health and surveillance.

Comply with all HIPAA privacy and security rules.

Practice management/billing, w/ online

eligibility.

ePrescribing with alerts and reminders.

Office-based Registry application

-Report generator either locally or as web service remotely

-Care plans based on guidelines

Documentation module

Patient web portal/PHR, with secure messaging and CCR-compliant viewing, downloading, and patient education/engagement capability.

Internet access to secure web server; local hospital, regional, national.

HIPAA privacy officer and program.

Clinical Groupware =

Modular, mobile, and modestly-priced platforms and software applications for physicians’ practices and hospitals that meet ONC/NIST certification criteria for meaningful use, security, and interoperability

Dennis Saver, MD“Boots on the Ground”

A view from a practicing physician

Questions and Comments?

Dennis Saver, MD

David C. Kibbe, MD MBA

The Kibbe Group LLC

email: [email protected]

telephone: 913. 205. 7968

home office: 594 D Woodbury Road

Fearrington Post

Pittsboro, NC 27312